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    椎间孔镜TESSYS技术治疗老年腰椎侧隐窝狭窄症

    Efficacy of percutaneous transforaminal endoscopic spine system in the treatment of elderly patients with lumbar lateral recess stenosis

    • 摘要: 目的探讨经皮椎间孔镜TESSYS(transforaminal endoscopic spine system)技术治疗老年腰椎侧隐窝狭窄症的临床效果。方法应用经皮椎间孔内镜下侧隐窝减压及椎间孔成形治疗25例老年腰椎侧隐窝狭窄症患者。其中,男15例,女10例。年龄61~88岁,平均年龄71.12岁。病程6个月~5年,平均10.1个月。随访12~24个月,平均16.5个月。术前患者主要表现为腰痛伴单侧下肢放射性疼痛,合并侧隐窝及椎间孔狭窄。手术均在局部麻醉下进行。均采用经皮椎间孔入路内镜下对侧隐窝进行减压及椎间孔成形治疗。术后6个月应用改良MacNab标准评定手术疗效。比较术前,术后1天及3、6个月患者的腿痛视觉模拟评分(VAS评分)及腰椎Oswestry功能障碍指数(ODI)。结果25例患者手术顺利,手术时间55~110 min,平均70 min,术中出血量10~40 ml,平均19 ml。1例患者术后腰痛缓解,出院后活动过多腿痛加重,经保守治疗后恢复正常。腿痛VAS评分术前(8.31±1.81)分,术后1天(3.11±0.82)分,术后3个月(1.80±0.36)分,术后6个月(1.54±0.35)分,术后各时间点腿痛的VAS评分较术前均明显改善(P<0.01)。腰椎ODI评分由术前的(66.30±9.80)分降至术后6个月的(18.07±4.30)分(P<0.01)。按照MacNab评分标准(术后6个月):优10例(40%),良14例(56%),差l 例(4%),优良率96%。结论椎间孔镜TESSYS技术治疗老年退变性腰椎管狭窄症创伤小,并发症少,近期疗效好;局麻下手术,对患者全身影响小;特别是对于合并多阶段侧隐窝狭窄以根性症状为主的患者治疗有一定的优势。

       

      Abstract: ObjectiveTo analyze the clinical efficacy of percutaneous transforaminal endoscopic spine system (TESSYS) in the treatment of elderly patients with lumbar lateral recess stenosis. MethodsA total of 25 elderly patients with lumbar lateral recess stenosis were performed percutaneous endoscopic decompression via transforaminal approach. There were 15 men and 10 women, with an average age of 71.12 years ranging from 61 to 88 years. The course of disease was 6 months to 5 years (10.1 months on the average) and the follow-up time was 12 to 24 months (16.5 months on the average). All patients presented back pain and sciatica to various degrees, in addition to stenosis in the lateral recess and lumbar intervertral foramen. Surgery was performed under local anesthesia. Percutaneous lumbar intentertebral foramen approach for decompression of lateral recess and treatment of intervertebral foramen were used on all cases. The surgical effect was evaluated using the MacNab scores six months after operation. The preoperative and postoperative visual analogue scale (VAS) on Day 1, and 3, 6 months after operation were used to evaluate leg pain, and the Oswestry disability index (ODI) was also evaluated. ResultsAll operations were successfully carried out. The operation time was 55 to 110 min (average 70 min) and the blood loss was 10 to 40 ml (average 19 ml). One case was complicated with leg pain recurrence after discharge and relieved by conservative therapy. After operation, the VAS of sciatica was decreased from (8.31±1.81) before operation, to (3.11±0.82) on Day 1 after operation, (1.80±0.36) on 3 months after operation and (1.54±0.35) 6 months after operation. The postoperative VAS scores of sciatica were significantly decreased compared with preoperative VAS scores (P<0.01). ODI was decreased from (66.3±9.8) before operation to (18.07±4.30) 6 month after operation. According to MacNab criteria, the surgical outcomes were excellent in 10 (40%) cases, good in 14 (56%) cases, fair in 1 (4%) case, with an excellent-to-good rate of 96% (P<0.01). ConclusionsPercutaneous TESSYS can treat elderly patients with degenerative lumbar spinal stenosis, with little trauma and complications. This technique can be performed under local anesthesia and has less impact on the general condition of patients. TESSYS gives advantage to the remedy of patients accompanied with stenosis in lateral recess.

       

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